| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99211 |
|
9,448 |
7,019 |
$108K |
| A4267 |
Male condom |
7,584 |
4,440 |
$104K |
| J3490 |
Drugs unclassified injection |
11,996 |
7,142 |
$87K |
| 87491 |
|
8,562 |
8,528 |
$63K |
| 99213 |
|
5,112 |
3,455 |
$47K |
| 99212 |
|
1,642 |
1,040 |
$29K |
| 81025 |
|
5,124 |
4,000 |
$27K |
| 99214 |
|
1,107 |
976 |
$21K |
| S4993 |
Contraceptive pills for bc |
2,112 |
1,291 |
$14K |
| 99201 |
|
1,357 |
1,037 |
$13K |
| J7307 |
Etonogestrel implant system |
230 |
170 |
$10K |
| S0199 |
Med abortion inc all ex drug |
656 |
318 |
$10K |
| 99000 |
|
3,476 |
2,869 |
$7K |
| Q0111 |
Wet mounts/ w preparations |
1,896 |
1,647 |
$4K |
| 87591 |
|
8,541 |
8,505 |
$3K |
| 87806 |
|
4,103 |
3,460 |
$3K |
| 76815 |
|
1,036 |
658 |
$2K |
| 11982 |
|
244 |
104 |
$1K |
| 99202 |
|
233 |
190 |
$1K |
| 83986 |
|
1,774 |
1,571 |
$1K |
| S0190 |
Mifepristone, oral, 200 mg |
470 |
258 |
$1K |
| 11981 |
|
267 |
163 |
$1K |
| 11976 |
|
27 |
14 |
$702.82 |
| 85018 |
|
949 |
580 |
$548.44 |
| Q0144 |
Azithromycin dihydrate, oral |
1,096 |
713 |
$163.68 |
| 86901 |
|
291 |
168 |
$0.00 |
| 58301 |
|
68 |
28 |
$0.00 |
| 58300 |
|
102 |
37 |
$0.00 |
| 59840 |
|
88 |
26 |
$0.00 |
| J7304 |
Contraceptive hormone patch |
14 |
12 |
$0.00 |
| J0696 |
Ceftriaxone sodium injection |
24 |
24 |
$0.00 |
| S0191 |
Misoprostol, oral, 200 mcg |
480 |
254 |
$0.00 |
| G2012 |
Brief check in by md/qhp |
237 |
234 |
$0.00 |
| 81002 |
|
92 |
79 |
$0.00 |